title: Reciprocal relations between physical disability, subjective health, and atrial fibrillation: the Framingham Heart Study.
abstract: BACKGROUND
  Atrial fibrillation (AF)-related symptoms and physical performance are relied upon to guide therapeutic management of patients with AF. We sought to understand whether AF predisposes to or is a result of physical disability and poor subjective health in the community.
  
  
  METHODS
  We studied relations between physical disability (Rosow-Breslau Functional Health Scale), subjective health (self-report) and incident AF, and the converse, in the Framingham Heart Study.
  
  
  RESULTS
  In 3,609 participants (age 73 ± 8 years, 59% women), a subset of 861 participants (24%) had prevalent physical disability at baseline. During 5.8 ± 1.8 years of follow-up, 555 participants (10-year age- and sex-adjusted incidence rate 13%) developed incident AF. Prevalent physical disability was related to incident AF (multivariable-adjusted hazard ratio 1.25, 95% CI 1.02-1.54, P = .03). In 3,525 participants, prevalent poor subjective health (n = 333) also was related to incident AF (n = 552, multivariable-adjusted hazard ratio 1.31, 95% CI 1.00-1.70, P = .048). Conversely, in 2,080 participants (age 69 ± 6 years, 55% women), interim AF (n = 106) was associated with newly reported physical disability (n = 573) at a follow-up examination (multivariable-adjusted odds ratio 1.58, 95% CI 1.08-2.31, P = .01). In 1,954 participants, interim AF (n = 96) likewise was related to newly reported poor subjective health (n = 224, multivariable-adjusted odds ratio 1.83, 95% CI 1.10-3.02, P = .02).
  
  
  CONCLUSIONS
  Physical disability and poor subjective health were related to incident AF in a community-based cohort. Conversely, interim AF was related to newly reported physical disability and poor subjective health. Because AF guidelines incorporate symptoms, it is essential to clarify the temporality and mechanisms linking physical disability, subjective health, and AF.
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Rienstra
authors.forename: Asya
authors.initials: A
authors.lastname: Lyass
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Murabito
authors.forename: Jared W
authors.initials: JW
authors.lastname: Magnani
authors.forename: Steven A
authors.initials: SA
authors.lastname: Lubitz
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Massaro
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Ellinor
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology / Q000534:rehabilitation; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology